Discussion
4.4 Theoretical implications of the current findings
The results from this study suggest that the mentalisation-based theoretical model and attachment theory offer a useful frameworks for understanding the complex
difficulties experienced by young people leaving local authority care. They also add to a growing body of research linking early trauma and childhood adversity to later life emotional and behavioural dysregulation. The mentalisation-based model of psychopathology builds on attachment theory, proposing that our understanding of the mental states of ourselves and others develops primarily (but not exclusively) in the context of early attachment relationships and can be disrupted by later trauma (Fonagy & Luyten, 2009). Young people requiring local authority care have invariably experienced disruptions in attachment relationships and/or trauma. Impaired social cognition in this group offers direct support for predictions made by the mentalisation-based model and supports emerging evidence suggesting that early trauma has a detrimental impact on social cognition (Nazarov et al., 2014; Preisler et
al., 2010). Fonagy and colleagues go on to suggest that the ability to ‘mentalise’ is
essential for effective representation and regulation of emotional states. This prediction is supported by the observed association between social cognition and emotional regulation in this sample. Given that social cognition is just one facet of the broader concept of ‘mentalisation’, we might expect that social cognitive ability would partially, but not wholly, mediate the relationship between early adversity (as indexed by requiring local authority care) and emotional dysregulation. The findings of this study supported this prediction. Likewise, an association was observed
between attachment anxiety and both emotional regulation and excess theory of mind attributions – which again is consistent with the mentalisation model.
The findings of this study provide a context for understanding how early negative experiences continue to have a detrimental effect on care-leavers during their
transition into adulthood. Difficulties in attachment relationships, impaired social cognition and emotional dysregulation are increasingly being recognised as important risk factors for a broad range of psychological difficulties (as discussed in Chapter 1 of this thesis). A tendency to over-interpret the mental states of others in social
situations could precipitate and maintain fears of rejection in attachment relationships, which may interact in a vicious cycle with dysregulated emotions, leading to
maladaptive coping strategies and impulsive behaviours (e.g. substance use, self- harm, aggressive behaviour, suicidal ideation or extremely isolative behaviour; Levy, 2005; Sharp et al., 2011b). More broadly, the findings from the current study lend support to other psychological models, most notably the biosocial theory that underpins dialectical behaviour therapy (Linehan, 1993a). According to this theory, pervasively invalidating experiences in childhood (including childhood adversity, attachment difficulties and interpersonal difficulties) are key components in the development and maintenance of emotional dysregulation and the behavioural and social concomitants.
This study has implications for theoretical understandings of the relationship between attachment and social cognition – a topic around which there is currently debate. Dykas and Cassidy (2011) argue that secure and insecure individuals differ in the way in which they process social information. Based on a review of the literature they propose that those who possess insecure internal working models (e.g. those who score highly on either attachment anxiety or avoidance) are more likely to use defensive systems to suppress attachment relevant social information leading to poor social cognitive ability over time. In contrast, Mikulincer and Shaver (2007) have proposed a model that differentiates more explicitly between attachment anxiety and avoidance. They suggest that anxious individuals are more likely to be hypervigilant to social cues and to ruminate about the mental states of others – leading to more sophisticated and accurate mentalisation over time. In contrast, they predict that avoidant people will be more likely to dismiss or divert attention from attachment- related cues and to deny or suppress attachment-related mental states – leading to less sophisticated and less accurate social cognitive abilities (Hunefeldt et al., 2013). Contrary to both these models, this study found that only attachment anxiety is significantly associated with less accurate mental state inferencing. One possible
explanation is that those who score more highly on attachment anxiety are hyper- vigilant to social cues (as predicted by Mikulincer and Shaver), but this leads to errors rather than ‘more accurate’ social cognition. Whereas those who are avoidant in attachment relationships may have developed good skills in interpreting the mental states of others as a means of exercising control in relationships and maintaining distance from others.
The finding from this study could have significant implications for understanding social functioning in young people leaving care. The ability to accurately process social signals is a prerequisite for consciously or unconsciously generating
appropriate responses. As such, social cognitive skills are necessary for successful interactions and facilitate the development of short and long-term relationships with significant others (Roepke et al., 2013). However, this study tells us little about the clinical significance of the observed deficits in social cognition in care-leavers. Whilst there is some evidence that social cognitive deficits on the MASC are related to markers of social functioning (e.g. social network size; Preller et al., 2013), further research is needed to elucidate the ‘real world’ impact of these impairments on social functioning. Likewise, we might expect attachment representations to predict social functioning, but the evidence to date is contradictory (Bohlin & Hagekull, 2009; Bohlin et al., 2000).
Finally, whilst the findings of this study place a number of difficulties within the individual, it is important not to ignore systemic factors. Social cognition is a not static and unitary concept, or trait. Inference about the mental states of others takes place within interpersonal contexts and in social settings (Liotti & Gilbert, 2011). It is therefore important to consider systemic factors and how they interact in maintaining and activating any tendency to over-interpret mental states of others. Young people leaving care are often thrust into independence (Stein, 2008) and are arguably one of the most vulnerable and disadvantaged groups in society (Tarren-Sweeney, 2008). As such, they are likely to be placed into situations, often deprived of the traditional supports of family, that activate patterns of attachment and idiosyncrasies in social cognition as a defensive means of coping with major life challenges.
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